Aims: The aim of this study is to assess the contribution of pollution by metals, organochlorines, and polycyclic aromatic hydrocarbons to reproductive outcome in a former eastern bloc country. This one of only a few large studies of high environmental pollution and pregnancy. Accomplishments: We examined concentration of metals in placenta. Lead and mercury concentrations were similar in the two cities; cadmium was somewhat higher in Kyiv. When compared to reports from many other countries and to a previous report from Ukraine, mercury, lead, and cadmium concentrations were low in both cities. The detection limit for arsenic was too high to allow meaningful comparison with the few existing studies from other regions. Zinc and copper were present at concentrations similar to those seen elsewhere; zinc was modestly higher in Kyiv than in Dniprodzerzhinsk. We examined concentrations of seven PAHs in placenta; all PAHs were detectable in all placentas, with the single exception of benzo(a)pyrene in one placenta. There is little comparative data available from general populations; reports describing PAH exposures tend to come from occupationally exposed groups and to involve measurement of urinary metabolites or of DNA adducts rather than of PAH concentrations. Concentrations were slightly higher in Kyiv than in Dniprodzerzhinsk. We examined the rate of preterm births among liveborns in both the complete enumeration and the main ELSPAC study. For ELSPAC participants, the rate was about 5 percent of live births; the rate for the entire census was slightly higher. Both are similar to rates reported elsewhere in Europe and considerably lower than US rates, even for whites. However, attempts to compare preterm rates, which conventionally are calculated on live births only, are fraught with problems; the high fetal mortality rate in Ukraine causes many preterm deliveries to be excluded from both the numerator and denominator of the preterm rate and thus lowers the apparent preterm rate. We also examined whether the predictors of preterm birth commonly seen in other studies predicted preterm birth in this population, and generally they did. Currently, patterns of hospitalization during pregnancy are being described; hospitalization is much more common in Ukraine than in the west, but this may reflect economic forces and customary patterns of care rather than higher rates of severe complications in the mothers.